MEDICARE: NADYA MARINA GADBERRY BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-18-65003
2	103K00000X	Behavior Analyst	1-21-51795	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-21-51795	OTHER	KY	BCBA CERTIFICATE

General Provider Information

NPI Number	:	1841753878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADYA MARINA GADBERRY BCBA

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	8739 OLD BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4490
Country	:	US
Telephone Number	:	502-208-6650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	06/22/2023

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